Paraphilias are defined as sexually arousing fantasies, urges, or behaviors involving either nonhuman objects; suffering or humiliation of oneself or one’s partner; or children or other non-consenting persons. In the DSM classification, paraphilias are subsumed under sexual disorders, while in the ICD paraphilias are classified as disorders of adult personality and behavior (disorders of sexual preference). Historically, some have advocated eliminating paraphilias or radically revising their definitions, while others suggested adhering to their traditional definitions. The classification and definition of paraphilias is complicated by cultural and societal underpinning, and the unclear boundaries between “normal” and “abnormal” sexuality. The diagnostic criteria of some paraphilias (e.g., pedophilia) are also complicated by the differences between the medical and the legal concepts of these entities. The recent attempts to introduce two new diagnoses, hypersexual disorder and paraphilic coercive disorder, into the DSM system stirred passionate scientific discussions about those two diagnoses and about paraphilias in general.

This presentation reviews the pros and cons of classifying paraphilias as sexual disorders and of including the new diagnoses of hypersexual disorder (unclear borders with “normality”) and paraphillic coercive disorder (unclear distinction between this entity and sexual sadism). In addition, this presentation reviews some of the more and/or less accepted methods of paraphilia management, such as pharmacotherapy and castration (chemical, surgical).

Several aspects of the classification and diagnosis of paraphilias remain controversial and some of the proposed changes seem unwarranted. Resolving diagnostic and management controversies could be helped by large multicenter and international field trials.